Asthma and Its Many Unmet Needs: Directions for Novel Therapeutic Approaches
|
|
- Gloria Wade
- 5 years ago
- Views:
Transcription
1 Asthma and Its Many Unmet Needs: Directions for Novel Therapeutic Approaches William W. Busse,, M.D. University of Wisconsin School of Medicine and Public Health Madison, WI, USA Disclosure Slide Employment University of Wisconsin Financial Interests Advisory Boards: GSK, Merck, Wyeth, Pfizer, Centocor, Amgen, Johnson & Johnson Consultant: Novartis, Genetech, Boehringer Ingelheim Research Interests NHLBI, NIAID, Novartis, Ception, MedImmune, GSK, AstraZeneca Organizational Interests AAAAI, ATS, AAP, ACAAI, AAI Gifts Nothing to Disclose Other Interests Nothing to Disclose
2 Objectives: Review current approaches to asthma treatment Review the effectiveness of guideline approaches to asthma Introduce the concept of asthma phenotypes Discuss approaches to personalized asthma treatment and development of novel therapeutic to meet these needs What characterizes asthma? Asthma is characterized by episodes of wheezing, cough, chest tightness and dyspnea The great majority of asthma patients have: Allergies (e.g. HDM, cat, molds, cockroach) Exercise-induced asthma (cold air) Nocturnal asthma Airway obstruction in asthma is typically reversible Nonspecific airway hyperresponsiveness can be demonstrated in the vast majority of patients with asthma
3 How have guidelines for asthma treatment benefitted care of this disease? Components of Severity Symptoms Classification of Asthma Severity (Youths 12 years of age and adults) Intermittent 2 days/week Mild >2 days/week but not daily Persistent Moderate Daily Severe Throughout the day Nighttime Awakenings 2x/month 3 4x/month >1x/week but not nightly Often 7x/week Impairment Normal FEV 1 /FVC: 8 19 yr 85% yr 80% yr 75% yr 70% Short-acting beta 2 -agonist use for symptom control (not prevention of EIB) Interference with normal activity Lung Function 2 days/week None Normal FEV 1 between exacerbations FEV 1 >80% predicted >2 days/week but not >1x/day Minor limitation FEV 1 >80% predicted Daily Some limitation FEV 1 >60% but <80% predicted Several times per day Extremely limited FEV 1 <60% predicted FEV 1 /FVC normal FEV 1 /FVC normal FEV 1 /FVC reduced 5% FEV 1 /FVC reduced >5% 0 2/year >2/year Risk Exacerbations (consider frequency and severity) Frequency and severity may fluctuate over time for patients in any severity category Relative annual risk of exacerbations may be related to FEV 1
4 Components of Severity Symptoms Classification of Asthma Severity (Youths 12 years of age and adults) Intermittent 2 days/week Mild >2 days/week but not daily Persistent Moderate Daily Severe Throughout the day Nighttime Awakenings 2x/month 3 4x/month >1x/week but not nightly Often 7x/week Impairment Normal FEV 1 /FVC: 8 19 yr 85% yr 80% yr 75% yr 70% Short-acting beta 2 -agonist use for symptom control (not prevention of EIB) Interference with normal activity Lung Function 2 days/week None Normal FEV 1 between exacerbations FEV 1 >80% predicted >2 days/week but not >1x/day Minor limitation FEV 1 >80% predicted Daily Some limitation FEV 1 >60% but <80% predicted Several times per day Extremely limited FEV 1 <60% predicted FEV 1 /FVC normal FEV 1 /FVC normal FEV 1 /FVC reduced 5% FEV 1 /FVC reduced >5% 0 2/year >2/year Risk Exacerbations (consider frequency and severity) Frequency and severity may fluctuate over time for patients in any severity category Relative annual risk of exacerbations may be related to FEV 1 Components of Severity Symptoms Classification of Asthma Severity (Youths 12 years of age and adults) Intermittent 2 days/week Mild >2 days/week but not daily Persistent Moderate Daily Severe Throughout the day Nighttime Awakenings 2x/month 3 4x/month >1x/week but not nightly Often 7x/week Impairment Normal FEV 1 /FVC: 8 19 yr 85% yr 80% yr 75% yr 70% Short-acting beta 2 -agonist use for symptom control (not prevention of EIB) Interference with normal activity Lung Function 2 days/week None Normal FEV 1 between exacerbations FEV 1 >80% predicted >2 days/week but not >1x/day Minor limitation FEV 1 >80% predicted Daily Some limitation FEV 1 >60% but <80% predicted Several times per day Extremely limited FEV 1 <60% predicted FEV 1 /FVC normal FEV 1 /FVC normal FEV 1 /FVC reduced 5% FEV 1 /FVC reduced >5% 0 2/year >2/year Risk Exacerbations (consider frequency and severity) Frequency and severity may fluctuate over time for patients in any severity category Relative annual risk of exacerbations may be related to FEV 1
5 How are these concepts incorporated into the Guidelines? Components of Severity Impairment Normal FEV 1 /FVC: 8 19 yr 85% yr 80% yr 75% yr 70% Risk Symptoms Nighttime awakenings Short-acting beta 2 -agonist use for symptom control (not prevention of EIB) Interference with normal activity Lung function Exacerbations (consider frequency and severity) Intermittent 2 days/week 2x/month 2 days/week None Normal FEV 1 between exacerbations FEV 1 >80% predicted FEV 1 /FVC normal 0 2/year Classification of Asthma Severity 12 years of age >2 days/week but not >1x/day Minor limitation FEV 1 >80% predicted >2/year Mild >2 days/week but not daily 3 4x/month FEV 1 /FVC normal Persistent Moderate Daily >1x/week but not nightly Daily Some limitation FEV 1 >60% but <80% predicted FEV 1 /FVC reduced 5% Frequency and severity may fluctuate over time for patients in any severity category Severe Throughout the day Often 7x/week Several times per day Extremely limited FEV 1 <60% predicted FEV 1 /FVC reduced >5% Relative annual risk of exacerbations may be related to FEV 1 Recommended Step for Initiating Treatment (See figure 4 5 for treatment steps) Step 1 Step 2 Step 3 Step 4 or 5 and consider short course of systemic oral corticosteroids In 2 6 weeks, evaluate level of asthma control that is achieved and adjust therapy accordingly.
6 Does this approach work? The Can Guideline-Defined Asthma Control Be Achieved? Gaining Optimal Asthma ControL (GOAL) Study E.D. Bateman et al. Am J Respir Crit Care Med 2004; 170:
7 GOAL Design Phase I Phase I 8- week control assessment Seretide 50/500 or FP 500 Seretide 50/250 or FP 250 Step 3 Seretide 50/100 or FP 100 Step 2 Step 1 Visit Week GOAL Study Patients (%) WELL CONTROLLED Asthma During Phase I 65% 71%* 52% 69%** FP Phase I Seretide Phase I 33% 51%** 20 0 Steroid-naive (S1) Low-dose ICS (S2) Moderate-dose ICS (S3) * P = **P < GOAL Study, Bateman E, et al ARJCCM 2004; 170:836
8 Given that asthma control is not universally achieved, what can be the next steps? Arthritis, anemia and asthma How are they all alike? They all are nonspecific and general characteristics of disease, describing swelling, low RBC numbers or reversible airway obstruction They shed almost no light on what caused these characteristics to develop Sally Wenzel, ATS 2010
9 Arthritis In rheumatology, no one would ever ultimately diagnose a patient with arthritis as the natural history, genetics, inflammatory processes and response to therapy will differ by which arthritis the patient has i.e., the understanding and treatment of RA will be vastly different from treatment of OA The same is likely true in asthma Sally Wenzel, ATS 2010 What is a phenotype? The relatively stable and observable characteristics of an organism resulting from interaction between its genetic make-up and environmental influences Peter Sterk, ATS 2010
10 Pathogenesis of Asthma Genetics Immune regulation Lung factors Age Environment Allergens Infections Microbes Pollution Asthma (Many Phenotypes) What about other approaches to identify asthma phenotypes?
11 Cluster Analysis Perform a multivariate cluster analysis to identify asthma groups who share similar phenotype profiles (defined by the factor scores identified in the variable reduction step) Moore et al. AJRCCM 2010; 181: Population studied in our cluster analysis Severe Asthma Research Program Started in 2000 Determine how severe asthma differs from non-severe asthma
12 Distribution of Variables Composite variables Objective Data 6% 6% 12% 6% 3% 12% 3% % % 6 15% 34 Total Variables, equally weighted Moore et al. AJRCCM 2010; 181: % PFTs: Baseline, Max Demos: Race, Gender, Ages Atopy; Skin tests Meds Triggers: Infxn, ASA, Allergy Sxs: Activity level HCU: Past 12 months Family Hx: Parents, Sibs Smoke Exposure Hormones PMH: GERD, HTN CLUSTER ANALYSIS: 5 CLUSTERS Cluster 1 n=110 Cluster 2 n=321 Cluster 3 n=59 Cluster 4 n=120 Cluster 5 n=116 P-value Age at Enrollment Gender (%female) Race (% Cauc/AAOther) Body Mass Index (BMI) Age of Asthma Onset (yrs) Asthma Duration (yrs) /29/ /30/ /22/ /33/ /20/ < < < < Baseline Lung Function* FEV1 % Predicted FVC % Predicted FEV1/FVC < < < Maximal Lung Function FEV1 % Predicted FVC % Predicted < < Atopy: % with 1 pos skin test 85% 78% 64% 83% 66% *Pre-bronchodilator values (>6 hours withhold of bronchodilators). Post-bronchodilator values after 6-8 puffs of albuterol Moore et al. AJRCCM 2010; 181:
13 CLUSTER ANALYSIS: 5 CLUSTERS Cluster 1 n=110 Cluster 2 n=321 Cluster 3 n=59 Cluster 4 n=120 Cluster 5 n=116 P-value Corticosteroid Use (%) None Low-moderate dose ICS High dose ICS* Oral or Systemic CS** Total Controllers(%) None 2 3 Health Care Utilization Pst Yr None 1 Urgent Visit and/or ED 3 Oral CS burst/yr Hospitalization 45% 38% 10% 11% 41% 41% 19% 67% 20% 11% 7% Moore et al. AJRCCM 2010; 181: % 40% 28% 10% 26% 46% 29% 61% 25% 19% 9% 14% 37% 49% 17% 10% 35% 54% 41% 34% 36% 15% 15% 18% 63% 39% 12% 33% 56% 38% 39% 46% 23% 5% 16% 78% 47% 4% 28% 67% 32% 42% 42% 28% * High dose ICS dose equivalent to 1000 fluticasone propionate daily; **Chronic oral corticosteroids (OCS) 20 mg daily or other systemic steroids in the past 3 months. Controllers include LTRA, ICS, LABA, theophyllines, OCS, omalizumab. P value from Chi-Square Analysis of ranked ordinal composite variables. < < < What about inflammatory markers, like eosinophils
14 Asthma Exacerbations and Sputum Eosinophil Counts: A Randomized Controlled Trial. Green et al. Lancet 2002; 360: Evaluated whether inhaled corticosteroid treatment directed towards reducing the sputum eosinophils was more effective than standard guideline care. Green et al. Lancet 2002; 360:
15 Cumulative Asthma Exacerbations in the BTS Management Group and the Sputum Management Group Green et al. Lancet 2002; 360: Haldar et al. Mepolizumab and exacerbations of refractory eosinophilic asthma. N Engl J Med 2009; 360: Evaluate the effect of reducing sputum eosinophils in patients refractory to usual asthma treatment Recruited subjects with persistent airway eosinophils despite aggressive anti-inflammatory treatment
16 Baseline Characteristics of Subjects in the Intention-to-Treat Population Characteristic Mepolizumab (N=29) Placebo (N=32) P Value Age (yr) Mean Severe exacerbations per subject in previous year (no.) FEV 1 after bronchodilator use (% of predicted value) 78.1± ± Eosinophil count in sputum (%) 6.84 ± ± Eosinophil count in blood (x10-9 /liter) 0.32 ± ± Dose of inhaled corticosteroid beclomethasone dipropionate equivalent (µg) Daily dose Use of oral prednisolone Regular use (% of subjects) Haldar, et al. NEJM 2009; 360: Haldar, et al. NEJM 2009; 360:
17 Haldar, et al. NEJM 2009; 360: How can phenotypic features be used to select patients more likely to respond to a specific treatment?
18 MA Berry et al. Evidence of a role of tumor necrosis factor-α in refractory asthma. N Eng J Med 2006; 354: Objective to evaluate the potential role of TNF-α in asthma Identified patients with treatment refractory asthma Selected normal subjects and asthma patients with low and high peripheral blood mononuclear cell expression of TNF- α receptor Berry et al. N Engl J Med 2006; 354:
19 Baseline Characteristics of the Subjects Berry et al. N Engl J Med 2006; 354: Berry et al. N Engl J Med 2006; 354:
20 Phenotypic characteristics based upon gene activation profiles PG Woodruff et al. T-helper type 2-driven inflammation defines major subphenotypes of asthma. Am J Respir Crit Care Med 2009; 180: To determine whether clinical heterogeneity is reflected in the heterogeneity of molecular mechanisms related to Th2 inflammation Using molecular approaches (microarrays and PCR), IL-13 inducible genes from bronchial brushings were determined
21 Gene expression microarray Heatmap depicting unsupervised hierarchical clustering of POSTN (periostin), ClCA1 (chloride channel regulator), and SERPINB2 (serpin peptidase inhibitor, clade) following IL-13 activation of epithelial cells. Woodruff et al. Am J Respir Crit Care Med 2009; 180: Relative expression of three genes induced by IL-13 Woodruff et al. Am J Respir Crit Care Med 2009; 180:
22 Expression levels of the Th2 cytokines, IL-4, IL-5, IL-13, in bronchial biopsy homogenates Th2 high asthma Th2 low asthma Normals Woodruff et al. Am J Respir Crit Care Med 2009; 180: Do patients with Th2-high asthma respond differently to inhaled corticosteroids?
23 Responsiveness of Th2-high asthma to inhaled steroids Woodruff et al. Am J Respir Crit Care Med 2009; 180: Subject characteristics and bronchoscopic features by a Th2-asthma phenotype Health Control Subjects Subjects with Asthma Th2 Signature Low Th2 Signature High P value Sample size Age, years FEV 1 % predicted Methacholine PC <0.001 IgE, IU/ml BAL eosinophil % FEV 1 with fluticasone at 4 wk, L N/A 0.03 ± ± FEV 1 with fluticasone at 8 wk, L N/A 0.04 ± ± Woodruff et al. Am J Respir Crit Care Med 2009; 180:
24 What is the future for treatment of asthma based upon individual patient characteristics? Determine associations between phenotype characteristics and genotype Develop patient profiles to detect Disease course At risk factors (exacerbations, loss of lung function) Treatment selection This approach promises to have greater specificity, predictability, effectiveness, and efficiency
Asthma Phenotypes, Heterogeneity and Severity: The Basis of Asthma Management
Asthma Phenotypes, Heterogeneity and Severity: The Basis of Asthma Management Eugene R. Bleecker, MD Professor and Director, Center for Genomics & Personalized Medicine Research Professor, Translational
More informationIdentification of Asthma Phenotypes using Cluster Analysis in the Severe Asthma Research Program
Moore online supp 1 Online Data Supplement Identification of Asthma Phenotypes using Cluster Analysis in the Severe Asthma Research Program Wendy C. Moore, MD, Deborah A. Meyers, PhD, Sally E. Wenzel,
More informationLearning the Asthma Guidelines by Case Studies
Learning the Asthma Guidelines by Case Studies Timothy Craig, DO Professor of Medicine and Pediatrics Distinguished Educator Penn State University Hershey Medical Center Objectives 1. Learn the Asthma
More informationCOPD or not COPD, that is the question.
COPD or not COPD, that is the question. Asthma-COPD Overlap Syndrome: ACOS Do we really need this? Michelle Harkins Disclosure Slide Slide help - William Busse, MD Organizational Interests ATS, ACCP, ACP
More informationUsing Patient Characteristics to Individualize and Improve Asthma Care
Using Patient Characteristics to Individualize and Improve Asthma Care Leonard B. Bacharier, M.D. Associate Professor of Pediatrics Clinical Director, Division of Allergy, Immunology, & Pulmonary Medicine
More informationImproving the Management of Asthma to Improve Patient Adherence and Outcomes
Improving the Management of Asthma to Improve Patient Adherence and Outcomes Robert Sussman, MD Atlantic Health System Overlook Medical Center Asthma Remains a Serious Health Risk in the US Every day in
More informationAsthma 2015: Establishing and Maintaining Control
Asthma 2015: Establishing and Maintaining Control Webinar for Michigan Center for Clinical Systems Improvement (Mi-CCSI) Karen Meyerson, MSN, APRN, NP-C, AE-C June 16, 2015 Asthma Prevalence Approx. 26
More informationDo We Need Biologics in Pediatric Asthma Management?
Do We Need Biologics in Pediatric Asthma Management? Ting Fan LEUNG, MBChB, MD, FRCPCH, FAAAAI Professor and Chairman Department of Paediatrics The Chinese University of Hong Kong Asthma and Allergy by
More informationPhenotypes of asthma; implications for treatment. Medical Grand Rounds Feb 2018 Jim Martin MD DSc
Phenotypes of asthma; implications for treatment Medical Grand Rounds Feb 2018 Jim Martin MD DSc No conflicts to declare Objectives To understand the varied clinical forms of asthma To understand the pathobiologic
More informationCurrent Asthma Therapy: Little Need to Phenotype. Phenotypes of Severe Asthma. Cellular Phenotypes 12/7/2012
Subbasement Membrane Thickness(µm) 12/7/212 Current Asthma Therapy: Little Need to Phenotype Phenotypes of Severe Asthma Most mild and to some degree moderate asthmatics respond well to currently available
More informationSubclinical phenotypes of asthma
1 Subclinical phenotypes of asthma P Bradding DM FRCP*, RH Green MD FRCP* * Institute for Lung Health and Department of Respiratory Medicine, Glenfield Hospital, Leicester, UK Department of Infection,
More informationOptimal Assessment of Asthma Control in Clinical Practice: Is there a role for biomarkers?
Disclosures: Optimal Assessment of Asthma Control in Clinical Practice: Is there a role for biomarkers? Stanley Fineman, MD Past-President, American College of Allergy, Asthma & Immunology Adjunct Associate
More informationDisclosures. Learning Objective. Biological therapies. Biologics with action against 11/30/2011. Biologic Asthma Therapies and Individualized Medicine
Biologic Asthma Therapies and Individualized Medicine Mark S. Dykewicz, MD Director, Allergy & Immunology Fellowship Program Director Wake Forest University School of Medicine Winston-Salem, North Carolina
More informationImproving Outcomes in the Management & Treatment of Asthma. April 21, Spring Managed Care Forum
Improving Outcomes in the Management & Treatment of Asthma April 21, 2016 2016 Spring Managed Care Forum David M. Mannino, M.D. Professor Department of Preventive Medicine and Environmental Health University
More informationAsthma. Rachel Miller, MD, FAAAAI Director Allergy and Immunology New York Presbyterian Hospital. Figure 1 Asthma Prevalence,
Asthma Rachel Miller, MD, FAAAAI Director Allergy and Immunology New York Presbyterian Hospital Figure 1 Asthma Prevalence, 1980-2000 * Gap between 1995-1996 and 1997 indicates a break in trend due to
More informationAsthma and Vocal Cord Dysfunction
Asthma and Vocal Cord Dysfunction Amy L. Marks DO, FACOP Pediatric Allergy and Immunology Assistant Professor of Pediatrics Oakland University William Beaumont School of Medicine Objectives: Understanding
More informationSearching for Targets to Control Asthma
Searching for Targets to Control Asthma Timothy Craig Distinguished Educator Professor Medicine and Pediatrics Penn State University Hershey, PA, USA Inflammation and Remodeling in Asthma The most important
More informationControversial Issues in the Management of Childhood Asthma: Insights from NIH Asthma Network Studies
Controversial Issues in the Management of Childhood Asthma: Insights from NIH Asthma Network Studies Stanley J. Szefler, MD Helen Wohlberg and Herman Lambert Chair in Pharmacokinetics, Head, Pediatric
More informationGoals and Learning Objectives
Small Airways (SAW) Symposium: Asthma Treatment Issues. New Bronchodilator for Asthma: A Patient Centric Approach for Treating Asthma Stephen P. Peters, MD, PhD, FAAAAI, FACP, FCCP, FCPP Thomas H. Davis
More informationCynthia S. Kelly, M.D. Professor of Pediatrics Eastern Virginia Medical School Division Director Allergy Children s Hospital of The King s Daughters
Cynthia S. Kelly, M.D. Professor of Pediatrics Eastern Virginia Medical School Division Director Allergy Children s Hospital of The King s Daughters Disclosures Speakers bureau of Novartis and Genentech
More informationBiologic Therapy in the Management of Asthma. Nabeel Farooqui, MD
Biologic Therapy in the Management of Asthma Nabeel Farooqui, MD None Disclosures Objectives Define severe asthma phenotypes and endotypes Describe the role of biologics in asthma management Review pivotal
More informationSevere Asthma(s): Can THEY be prevented or reversed?
Severe Asthma(s): Can THEY be prevented or reversed? Sally Wenzel, MD Professor of Medicine UPMC Chair in Translational Airway Biology Disclosures Sally Wenzel, M.D. Grant/Research Support: Boehringer-Ingelheim,
More information12/18/2017. Disclosures. Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing
Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Diana M. Sobieraj, PharmD, BCPS Assistant Professor University of Connecticut School
More informationInhaler Confusion. Today s Speaker Dr. Randall Brown. Director of Asthma Programs 6/7/2016. Dr. Randall Brown March 31, 2016
+ Inhaler Confusion Dr. Randall Brown March 31, 2016 + Today s Speaker Dr. Randall Brown Director of Asthma Programs Center for Managing Chronic Disease University of Michigan 1 ASTHMA ESSENTIALS IN PRIMARY
More informationAsthma Therapy 2017 JOSHUA S. JACOBS, M.D.
Asthma Therapy 2017 JOSHUA S. JACOBS, M.D. BACKGROUND-PREVALENCE Asthma is one of the most common chronic diseases worldwide with an estimated 300 million affected individuals Prevalence is increasing
More informationBiologics in asthma Are we turning the corner? Roland Buhl Pulmonary Department Mainz University Hospital
Biologics in asthma Are we turning the corner? Roland Buhl Pulmonary Department Mainz University Hospital Biologics in asthma - are we turning the corner? Allergic asthma anti - IgE Allergic airway inflammation
More informationOutline FEF Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications?
Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications? Fernando Holguin MD MPH Director, Asthma Clinical & Research Program Center for lungs and Breathing University of Colorado
More informationAsthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing
Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Diana M. Sobieraj, PharmD, BCPS Assistant Professor University of Connecticut School
More informationPediatric Asthma: Pharmacotherapy. Joseph Spahn, MD Children s Hospital Colorado & University of Colorado Medical School Aurora, Colorado
Pediatric Asthma: Pharmacotherapy Joseph Spahn, MD Children s Hospital Colorado & University of Colorado Medical School Aurora, Colorado Pediatric Asthma: Pharmacotherapy Disclosures/Conflicts of Interest:
More informationAsthma ASTHMA. Current Strategies for Asthma and COPD
Current Strategies for Asthma and COPD Talmadge E. King, Jr., M.D. Krevins Distinguished Professor of Medicine Chair, Department of Medicine University of California San Francisco (UCSF) San Francisco,
More informationStep up if needed (first, check adherence, environmental control and comorbid conditions) Patients ASSESS CONTROL. Step down if possible
12/9/212 Pharmacogenomics Treating the Individual Asthma Patient Elliot Israel, M.D. Professor of Medicine Harvard Medical School Brigham & Women s Hospital Partners Asthma Center Too much of a good thing?
More informationAmanda Hess, MMS, PA-C President-Elect, AAPA-AAI Arizona Asthma and Allergy Institute Scottsdale, AZ
Amanda Hess, MMS, PA-C President-Elect, AAPA-AAI Arizona Asthma and Allergy Institute Scottsdale, AZ Financial Disclosures Advanced Practiced Advisory Board for Circassia Learning Objectives 1. Briefly
More informationPrimary Care Medicine: Concepts and Controversies Wed., February 17, 2010 Fiesta Americana Puerto Vallarta, Mexico Update on Asthma and COPD
Primary Care Medicine: Concepts and Controversies Wed., February 17, 2010 Fiesta Americana Puerto Vallarta, Mexico Update on Asthma and COPD Talmadge E. King, Jr., M.D. Krevins Distinguished Professor
More information#1 cause of school absenteeism in children 13 million missed days annually
Asthma Update 2013 Jennifer W. McCallister, MD, FACP, FCCP Associate Professor Pulmonary & Critical Care Medicine The Ohio State University Wexner Medical Center Disclosures None 2 Objectives Review burden
More informationAsthma and COPD. Health Net Provider Educational Webinar
Asthma and COPD Health Net Provider Educational Webinar AstraZeneca 2015 Disclosures Presenters today are employed by Astra Zeneca and have nothing to disclose. This presentation is free from bias. 2 Objectives
More informationNational Institutes of Health (NIH) NAEPP 2007 Asthma Guideline UPDATE. Susan K. Ross RN, AE-C MDH Asthma Program.
National Institutes of Health (NIH) NAEPP 2007 Asthma Guideline UPDATE Susan K. Ross RN, AE-C MDH Asthma Program 651-201 201-5629 Susan.Ross@health.state.mn.us 1 National Institutes of Health National
More informationAdult asthma management: focus on control
Adult asthma management: focus on control Jennifer W. McCallister, MD Associate Professor Pulmonary, Allergy, Critical Care & Sleep Medicine The Ohio State University Wexner Medical Center Objectives Apply
More informationWhat s new in COPD? Apichart Khanichap MD. Department of Medicine, Faculty of Medicine, Thammasat university
What s new in COPD? Apichart Khanichap MD. Department of Medicine, Faculty of Medicine, Thammasat university Management stable COPD Relieve symptoms Improve exercise tolerance Improve health status Prevent
More informationMeeting the Challenges of Asthma
Presenter Disclosure Information 11:05 11:45am Meeting the Challenge of Asthma SPEAKER Christopher Fanta, MD The following relationships exist related to this presentation: Christopher Fanta, MD: No financial
More informationPresented by the California Academy of Family Physicians 2013/California Academy of Family Physicians
Family Medicine and Patient-Centered Asthma Care Presented by the California Academy of Family Physicians Faculty: Hobart Lee, MD Disclosures: Jeffrey Luther, MD, Program Director, Memorial Family Medicine
More informationAsthma in the Athlete
Asthma in the Athlete Jorge E. Gomez, MD Associate Professor Texas Children s Hospital Baylor College of Medicine Assist Team Physician UH Understand how we diagnose asthma Objectives Be familiar with
More informationClinical Implications of Asthma Phenotypes. Michael Schatz, MD, MS Department of Allergy
Clinical Implications of Asthma Phenotypes Michael Schatz, MD, MS Department of Allergy Definition of Phenotype The observable properties of an organism that are produced by the interaction of the genotype
More informationBronchial Provocation Results: What Does It Mean?
Bronchial Provocation Results: What Does It Mean? Greg King 1 Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards 2065 2 Woolcock Institute of Medical Research and Sydney Medical
More informationProf Neil Barnes. Respiratory and General Medicine London Chest Hospital and The Royal London Hospital
Prof Neil Barnes Respiratory and General Medicine London Chest Hospital and The Royal London Hospital ASTHMA: WHEN EVERYTHING FAILS WHAT DO YOU DO? South GP CME 2013, Dunedin Saturday 17 th August 2013
More informationAsthma Update A/Prof. John Abisheganaden. Senior Consultant, Dept Of Respiratory & Crit Care Medicine Tan Tock Seng Hospital
Asthma Update - 2013 A/Prof. John Abisheganaden Senior Consultant, Dept Of Respiratory & Crit Care Medicine Tan Tock Seng Hospital Asthma A complex syndrome Multifaceted disease Heterogeneous Genetic and
More informationRecurrent Wheezing in Preschool Children. William Sheehan, MD Associate Professor of Pediatrics Division of Allergy and Immunology
Recurrent Wheezing in Preschool Children William Sheehan, MD Associate Professor of Pediatrics Division of Allergy and Immunology Disclosure I have nothing to disclose related to this talk. Background
More informationTHE PROMISE OF NEW AND NOVEL DRUGS. Pyng Lee Respiratory & Critical Care Medicine National University Hospital
THE PROMISE OF NEW AND NOVEL DRUGS Pyng Lee Respiratory & Critical Care Medicine National University Hospital Pyng_lee@nuhs.edu.sg Asthma Prevalence, Morbidity, Mortality 235 million suffer from asthma
More informationHeterogeneity of COPD and Asthma
Heterogeneity of COPD and Asthma from Heterogeneity to Stratification Dr. Y-M Oh Asan Medical Center Seoul Congratulations & Welcome Lee,SD Ohno, Y Park, JS Seo, JB 8 th Internat nal Workshop on Pul. Functional
More informationBiologic Agents in the treatment of Severe Asthma
Biologic Agents in the treatment of Severe Asthma Daniel L Maxwell, D.O., FACOI, FAASM Clinical Assistant Professor of Medicine Michigan State University College of Osteopathic Medicine College of Human
More informationNational Institutes of Health (NIH) NAEPP 2007 Asthma Guideline Expert Panel Report (EPR) 3
National Institutes of Health (NIH) NAEPP 2007 Asthma Guideline Expert Panel Report (EPR) 3 Susan K. Ross RN, AE C MDH Asthma Program 651 201 201 5629 Susan.Ross@state.mn.us 1 National Institutes of Health
More informationCOPD and Asthma Update. April 29 th, 2017 Rachel M Taliercio, DO Staff, Respiratory Institute
COPD and Asthma Update April 29 th, 2017 Rachel M Taliercio, DO Staff, Respiratory Institute What we ll be talking about COPD: diagnosis, management of stable COPD, COPD exacerbations Asthma: diagnosis,
More informationThe Asthma Guidelines: Diagnosis and Assessment of Asthma
The Asthma Guidelines: Diagnosis and Assessment of Asthma Christopher H. Fanta, M.D. Partners Asthma Center Brigham and Women s Hospital Harvard Medical School Objectives Know how the diagnosis of asthma
More informationAsthma and COPD in older people lumping or splitting? Christine Jenkins Concord Hospital Woolcock Institute of Medical Research
Asthma and COPD in older people lumping or splitting? Christine Jenkins Concord Hospital Woolcock Institute of Medical Research Concord Hospital Woolcock Institute of Medical Research Joe has asthma What
More informationDistinction and Overlap. Allergy Dpt, 2 nd Pediatric Clinic, University of Athens
Asthma Phenotypes: Distinction and Overlap Nikos Papadopoulos Allergy Dpt, 2 nd Pediatric Clinic, University of Athens Asthma as a syndrome From the Iliad to ADAM 33 and back again Bronchoconstriction,
More informationNew Therapies for Asthma
New Therapies for Asthma Tracy Bridges, MD Speaker Disclosure: Dr. Bridges participates in speaker bureaus for Teva, Genetech & Astra Zeneca. Objectives: Discuss the use of LAMA s for Asthma Detail the
More informationImproving asthma outcomes though education
Improving asthma outcomes though education Segment 1 Clinical Aspects of Asthma and Long term Plan Primary Care and Asthma Most common chronic disease of childhood. Primary care providers are expected
More informationBreakfast Session Prof Neil Barnes Professor of Respiratory Medicine London Chest Hospital & The Royal London Hospital United Kingdom
Breakfast Session Prof Neil Barnes Professor of Respiratory Medicine London Chest Hospital & The Royal London Hospital United Kingdom 2 BEYOND SYMPTOMS ADDRESSING FUTURE RISK IN ASTHMA South GP CME 2013,
More informationCOPD COPD. Update on COPD and Asthma
Update on COPD and Asthma Talmadge E. King, Jr., M.D. Krevins Distinguished Professor of Medicine Chair, Department of Medicine University of California San Francisco (UCSF) San Francisco, CA COPD COPD
More informationDiagnosis, Assessment, Monitoring and Pharmacological Treatment of Asthma
Diagnosis, Assessment, Monitoring and Pharmacological Treatment of Asthma Magnitude of Asthma - India Delhi Childhood asthma: 10.9% Adults: 8% Other Cities 3 to 18% Chhabra SK et al Ann Allergy Asthma
More informationAsthma COPD Overlap (ACO)
Asthma COPD Overlap (ACO) Dr Thomas Brown Consultant Respiratory Physician Thomas.Brown@porthosp.nhs.uk Dr Hitasha Rupani Consultant Respiratory Physician Hitasha.rupani@porthosp.nhs.uk What is Asthma
More informationEmily DiMango, MD Asthma II
Emily DiMango, MD Asthma II Director John Edsall/John Wood Asthma Center Columbia University Medical Center HP 2000 Goal: 2.25/1,000 Comparison of Asthma Hospitalization Rates in Children Aged 0-14 in
More informationAnti-IgE Treatment In Severe Asthma. Thomas B. Casale, MD Professor of Medicine Chief, Allergy/Immunology Creighton University Omaha, NE
Anti-IgE Treatment In Severe Asthma Thomas B. Casale, MD Professor of Medicine Chief, Allergy/Immunology Creighton University Omaha, NE Relevant Disclosures Financial Relationship/Consulting Fees: Value
More informationTreatment Responses. Ronald Dahl, Aarhus University Hospital, Denmark
Asthma and COPD: Are They a Spectrum Treatment Responses Ronald Dahl, Aarhus University Hospital, Denmark Pharmacological Treatments Bronchodilators Inhaled short-acting β -Agonist (rescue) Inhaled short-acting
More informationAsthma Pathophysiology and Treatment. John R. Holcomb, M.D.
Asthma Pathophysiology and Treatment John R. Holcomb, M.D. Objectives Definition of Asthma Epidemiology and risk factors of Asthma Pathophysiology of Asthma Diagnostics test of Asthma Management of Asthma
More informationAsthma: Classification, Management, Prevention and New Treatments
Asthma: Classification, Management, Prevention and New Treatments Cori Daines, MD, Professor Pediatric Pulmonary Medicine University of Arizona April 28, 2018 I have no relevant financial relationships
More informationMethacholine versus Mannitol Challenge in the Evaluation of Asthma Clinical applications of methacholine and mannitol challenges
Methacholine versus Mannitol Challenge in the Evaluation of Asthma Clinical applications of methacholine and mannitol challenges AAAAI San Antonio Tx February 2013 Catherine Lemière MD, MSc Hôpital du
More informationPreschool Asthma What you need to know in 10 minutes
Preschool Asthma What you need to know in 10 minutes Alan Kaplan MD CCFP(EM) FCFP Family Physician Airways Group of Canada Respiratory Medicine section CFPC Faculty/Presenter Disclosure Faculty: Alan Kaplan
More informationDrug Prior Authorization Guideline NUCALA (mepolizumab)
Drug Prior Authorization Guideline MB9914 Covered Service: Prior Authorization Required: Additional Information: Yes when meets criteria below Yes as shown below Restricted to Pulmonology, Allergy, and
More informationDistinguishing Type-2 Asthma
UPDATE ON ASTHMA THERAPY: MATCHING PHENOTYPE TO TREATMENT Sally E. Wenzel, MD Professor of Medicine University of Pittsburgh Asthma Institute@UPMC Subsection Chief of Allergy 1234567 891234 567891 2345678
More informationDifficult Asthma Assessment: A systematic approach
Difficult Asthma Assessment: A systematic approach Dr Naghmeh Radhakrishna Respiratory, Sleep & Allergy Physician Allergy, Asthma & Clinical Immunology Service The Alfred Hospital Melbourne, Australia
More informationDisclosures. The Montreal Protocol. The Spectrum of Obstructive Lung Disease: Asthma & COPD. The Spectrum of Obstructive Lung Disease: Asthma & COPD
The Spectrum of Obstructive Lung Disease: Asthma & COPD Disclosures No Pharma Consulting, Research, Lectures Stephen C. Lazarus, M.D. Division of Pulmonary & Critical Care Medicine Cardiovascular Research
More informationASTHMA BEST PRACTICES FOR SCHOOL NURSES. School Nurses November 2015
ASTHMA BEST PRACTICES FOR SCHOOL NURSES School Nurses November 2015 1 BACKGROUND AND CURRENT STATS General definitions and explanations 2 Incidence of Asthma Centers for Disease Control (CDC) - 1 in 12
More informationRobert Kruklitis, MD, PhD Chief, Pulmonary Medicine Lehigh Valley Health Network
Robert Kruklitis, MD, PhD Chief, Pulmonary Medicine Lehigh Valley Health Network Robert.kruklitis@lvh.com Correlation of a Asthma pathophyisology with basic science Asthma (Physiology) Bronchodilators
More informationQ: Should patients with mild asthma
1-MINUTE CONSULT CME CREDIT EDUCATIONAL OBJECTIVE: Readers will consider prescribing inhaled corticosteroids to their patients who have mild persistent asthma brief answers to specific clinical questions
More informationasthma, order-made medicine, phenotypes 2.1 Cluster analysis by Haldar et al.
Received: 8 June 2015 Accepted: 25 February 2016 DOI: 10.1002/jgf2.7 REVIEW ARTICLE Asthma phenotypes Masahiro Hirose MD, PhD Takahiko Horiguchi MD, PhD Department of Respiratory Medicine II, Fujita Health
More informationAsthma Update I have no professional or personal financial conflicts of interest to disclose.
Asthma Update 2018 Disclosures Jennifer W. McCallister, MD, FACP, FCCP Associate Professor Division of Pulmonary, Critical Care, and Sleep Medicine The Ohio State University Wexner Medical Center I have
More informationAsthma Update Jennifer W. McCallister, MD, FACP, FCCP
Asthma Update 2018 Jennifer W. McCallister, MD, FACP, FCCP Associate Professor Division of Pulmonary, Critical Care, and Sleep Medicine The Ohio State University Wexner Medical Center Disclosures I have
More informationDecember 7, 2010 Future Use of Biologics in Allergy and Asthma
December 7, 2010 Future Use of Biologics in Allergy and Asthma Lanny J. Rosenwasser, M.D. Dee Lyons/Missouri Endowed Chair in Immunology Research Professor of Pediatrics Allergy-Immunology Division Childrens
More informationDual-Controller Asthma Therapy: Rationale and Clinical Benefits
B/1 Dual-Controller Asthma Therapy: Rationale and Clinical Benefits MODULE B The 1997 National Heart, Lung, and Blood Institute (NHLBI) Expert Panel guidelines on asthma management recommend a 4-step approach
More informationAdult Asthma Clinical Practice Guideline Summary
Adult Asthma Clinical Practice Guideline Summary The following evidence-based guideline was developed to assist Primary Care physicians and other clinicians in the management of asthma in adults. It was
More informationSmooth Muscle & Asthma: Bronchial Thermoplasty - A Smooth Muscle Modifier
Smooth Muscle & Asthma: Bronchial Thermoplasty - A Smooth Muscle Modifier Mario Castro, MD, MPH Professor of Medicine and Pediatrics Director, The Asthma and Airway Translational Research Unit, Washington
More informationSCREENING AND PREVENTION
These protocols are designed to implement standard guidelines, based on the best evidence, that provide a consistent clinical experience for AHC II Integrated Clinical Delivery Network patients and allow
More informationPredicting, Preventing and Managing Asthma Exacerbations. Heather Zar Department of Paediatrics & Child Health University of Cape Town South Africa
Predicting, Preventing and Managing Asthma Exacerbations Heather Zar Department of Paediatrics & Child Health University of Cape Town South Africa Asthma exacerbations Predicting exacerbation recognising
More informationIdentifying Biologic Targets to Attenuate or Eliminate Asthma Exacerbations
Identifying Biologic Targets to Attenuate or Eliminate Exacerbations exacerbations are a major cause of disease morbidity and costs. For both children and adults, viral respiratory infections are the major
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: bronchial_thermoplasty 10/2010 3/2018 3/2019 3/2018 Description of Procedure or Service Bronchial thermoplasty
More informationDifferent kinds of asthma, different kinds of therapies
Different kinds of asthma, different kinds of therapies Friday 10 th November 2017 XXXIII Congresso Sezione SIAAIC Toscana Professor Neil Barnes Medical Head Global Respiratory Franchise, GSK Brentford,
More informationCOPD: A Renewed Focus. Disclosures
COPD: A Renewed Focus Heath Latham, MD Assistant Professor Division of Pulmonary and Critical Care Medicine Disclosures No Business Interests No Consulting No Speakers Bureau No Off Label Use to Discuss
More informationLearning Objective. Asthma. Discuss the pathophysiology, clinical presentation, diagnosis, and treatment of Asthma 2/22/2017
Marianne Curran, PA C 3/1/17 Learning Objective Discuss the pathophysiology, clinical presentation, diagnosis, and treatment of Definition many variations Chronic Disorder with Reversible (Intermittent
More informationWhat is this patient s diagnosis?
Asthma and COPD KANTA VELAMURI, MD ASSOCIATE PROFESSOR OF MEDICINE PULMONARY, CRITICAL CARE AND SLEEP MEDICINE SECTION MICHAEL E. DEBAKEY VA MEDICAL CENTER BAYLOR COLLEGE OF MEDICINE Disclosures None Case
More informationDisclosures. Update on COPD & Asthma. Update on the Management of COPD. No Pharma Disclosures. NHLBI - Asthma Clinical Research Network
Update on COPD & Asthma Michael C. Peters, M.D. MAS Division of Pulmonary & Critical Care Medicine Cardiovascular Research Institute University of California San Francisco UCSF Primary Care Medicine San
More informationClinical Benefits of FeNO Monitoring in Asthma RYAN BURTON, MS, RPFT
Clinical Benefits of FeNO Monitoring in Asthma RYAN BURTON, MS, RPFT Disclosures I am an employee of Circassia Pharmaceuticals. Objectives Nitric Oxide Inflammation in Asthma Phenotyping Personalized Medicine
More informationAdd on therapy in asthma. Local experience in context J Paul Dilworth, Nicola Marks, Lauren Geddes
Add on therapy in asthma Local experience in context J Paul Dilworth, Nicola Marks, Lauren Geddes Programme Omalizumab Evidence and assessment Local Experience Dysfunctional breathing The other effective
More informationExercise-Induced Bronchospasm. Michael A Lucia, MD, FCCP Asst Clinical Professor, UNR School of Medicine Sierra Pulmonary & Sleep Institute
Exercise-Induced Bronchospasm Michael A Lucia, MD, FCCP Asst Clinical Professor, UNR School of Medicine Sierra Pulmonary & Sleep Institute EIB Episodic bronchoconstriction with exercise May be an exacerbation
More informationUnderstanding Early Wheezing in the Development of Airflow Limitation in Children
Understanding Early Wheezing in the Development of Airflow Limitation in Children Bradley Chipps, MD Capital Allergy & Respiratory Disease Center Sacramento, CA Western Society of Allergy, Asthma and Immunology
More informationOmalizumab (Xolair ) ( Genentech, Inc., Novartis Pharmaceuticals Corp.) September Indication
( Genentech, Inc., Novartis Pharmaceuticals Corp.) September 2003 Indication The FDA recently approved Omalizumab on June 20, 2003 for adults and adolescents (12 years of age and above) with moderate to
More informationEffective Date: 4/27/2016 Version: 1.0 Approval By: CCC Clinical Delivery Steering Planned Review Date: 4/27/2017
Protocol Title: Adult Asthma Protocol Effective Date: 4/27/2016 Version: 1.0 Approval By: CCC Clinical Delivery Steering Planned Review Date: 4/27/2017 1 Purpose & Objective This protocol provides evidence-based
More informationPediatric Asthma Management
Pediatric Asthma Management APRN Conference February 2016 Cheryl Kerrigan, MSN, CPNP Aimee Tiller RN, AE-C The Plan Definition Pathophysiology review Triggers & Risk Factors Incidence and Prevalence Making
More informationPediatric and Adult. Disclosure. Asthma. Learning Objectives. EPR-3: What s Changed? Asthma: Pediatric and Adult
Asthma: Pediatric and Adult Americo D. Fraboni, MD, FAAFP Assistant Clinical Professor Department of Family Practice & Community Health University of Minnesota Medical School Minneapolis, Minnesota Disclosure
More information#POMAD8 #ChoosePOMA #POMAD8 #ChoosePOMA #POMAD8 #ChoosePOMA
Where There s Smoke There s Obstruction Stephen G. Basheda, D.O., F.C.C.P. 1 Disclosures Dr. Basheda is an independent contractor for AstraZeneca Pharmaceuticals, LP and GlaxoSmithKline and on the speaker
More informationCOPD: From Phenotypes to Endotypes. MeiLan K Han, M.D., M.S. Associate Professor of Medicine University of Michigan, Ann Arbor, MI
COPD: From Phenotypes to Endotypes MeiLan K Han, M.D., M.S. Associate Professor of Medicine University of Michigan, Ann Arbor, MI Presenter Disclosures MeiLan K. Han Consulting Research support Novartis
More information